Chen Y-Q, Zhu X-L, You Y-W, Zhang Q, Dai T
Institute of Medical Information, Medical Library, Chinese Academy of Medical Sciences, Beijing, China.
Eur Rev Med Pharmacol Sci. 2023 Feb;27(4):1398-1412. doi: 10.26355/eurrev_202302_31377.
The aging society and the empty nest of the elderly have become issues that cannot be ignored by the Chinese government. Not only does the physical function of the empty-nest elderly (ENE) decline, and the incidence and prevalence of chronic diseases increase significantly, but they are also more likely to have loneliness, low life satisfaction, mental health problems, and even a much greater possibility of suffering from depression than the nonempty-nest elderly, besides the possibility of catastrophic health expenditure (CHE) which is also greatly increased. This paper aims to evaluate the status quo of dilemma and determinants of a vast sample of subjects based on the national level.
Data were obtained from the latest 2018's data of the China Health and Retirement Longitudinal Study (CHARLS). Under the guidance of Andersen's model of health services utilization, this study clarified the overall and different demographic characteristics and prevalence of CHE among ENE and further built the Logit and Tobit model to explore the determinants of CHE occurrence and its intensity.
A total of 7,602 ENE were included in the analysis, and the overall incidence of CHE among them was 21.20%. Poor self-reported health status (OR=2.03, 95% CI: 1.71-2.35), suffering from three or more chronic diseases simultaneously (OR=1.79, 95% CI: 1.42-2.15), low life satisfaction (OR=1.44, 95% CI: 1.20-1.68) and advanced age played the leading role in accounting for its high risk, and its intensity increased 0.0311 (SE=0.005), 0.0234 (SE=0.007), and 0.0178 (SE=0.005), respectively. In contrast, the leading drop in the probability of CHE among ENE was those whose monthly income was over 20,000 CNY (OR=0.46, 95% CI: 0.38-0.55), whose intensity declined 0.0399 (SE=0.005), whose monthly income was between 2,000 and 20,000 CNY (OR=0.78, 95% CI: 0.66-0.90) and whose intensity declined 0.021 (SE=0.005), and who were married during the survey period (OR=0.82, 95% CI: 0.70-0.94). Simultaneously, rural ENE showed more vulnerability and higher risk of CHE when confronted with these factors compared with the urban ones.
More attention should be paid for ENE in China. The priority, including the relevant health insurance or social security measurements, should be further strengthened.
老龄化社会以及老年人空巢化已成为中国政府不可忽视的问题。空巢老人不仅身体机能下降，慢性病发病率和患病率显著上升，而且比非空巢老人更容易感到孤独、生活满意度低、出现心理健康问题，甚至患抑郁症的可能性也大大增加，此外，灾难性卫生支出（CHE）的可能性也大幅上升。本文旨在基于国家层面评估大量样本对象的困境现状及其决定因素。
数据来源于中国健康与养老追踪调查（CHARLS）2018年的最新数据。在安德森卫生服务利用模型的指导下，本研究阐明了空巢老人的总体及不同人口学特征以及CHE的患病率，并进一步构建Logit和Tobit模型以探究CHE发生及其强度的决定因素。
分析共纳入7602名空巢老人，其CHE总体发生率为21.20%。自我报告健康状况差（OR=2.03，95%CI：1.71-2.35）、同时患有三种及以上慢性病（OR=1.79，95%CI：1.42-2.15）、生活满意度低（OR=1.44，95%CI：1.20-1.68）以及高龄在导致其高风险方面起主要作用，且其强度分别增加0.0311（SE=0.005）、0.0234（SE=0.007）和0.0178（SE=0.005）。相比之下，空巢老人中CHE发生概率下降最明显的是月收入超过20000元的人群（OR=0.46，95%CI：0.38-0.55），其强度下降0.0399（SE=0.005），月收入在2000至20000元之间的人群（OR=0.78，95%CI：0.66-0.90），其强度下降0.021（SE=0.005），以及在调查期间已婚的人群（OR=0.82，95%CI：0.70-0.94）。同时，与城市空巢老人相比，农村空巢老人在面对这些因素时表现出更大的脆弱性和更高的CHE风险。
中国应更加关注空巢老人。应进一步加强包括相关医疗保险或社会保障措施在内的重点工作。
